Terlipressin in patients with septic shock: friend or foe?

Excerpt

Sir: Dr Westphal et al. have properly posed the problem of the risk of oxygen supply dependency after terlipressin administration. In their recent and well-designed works, Westphal and co-workers [1, 2] clearly show that this is a possible occurrence, and hence, it is something that we must take into account every time we administer terlipressin. In accordance with the comments of the authors, we think that this risk is markedly increased in patients with a low-flow state and intact baroreflex response. In a recent experience of ours (unpublished data) in patients with a low-flow state, terlipressin further decreased cardiac output and depressed both oxygen delivery and consumption, suggesting that these patients suffered from “iatrogenic” oxygen supply dependency. In presence of these hemodynamics, the use of terlipressin must be carefully evaluated and considered only when other vasopressors are ineffective (i.e., patients chronically treated with renin-angiotensin system inhibitors) [3]. …